การวิเคราะห์ความซับซ้อนของการขยายผลการจัดบริการลดอันตรายจากการใช้ยาเสพติดสู่การปฏิบัติในโรงพยาบาลชุมชน จังหวัดแม่ฮ่องสอน

Abstract

This study aimed to explore and analyze complexity of the spreading of harm reduction service in community hospitals, Mae Hong Son province. The service has been effectively implemented in Thanyarak Hospitals, but many problems and barriers has been found at the operational level in community hospitals. The study was divided into two phases. The first phase was to explore complexity of the spreading of harm reduction service in two community hospitals in Mae Hong Son: Pang Mapha and Mae La Noi. Data were collected by in-depth interview in compliance with 7 domains of a modified Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework: condition, technology, adopter system, value proposition, healthcare organization, wider system, embedding and adaptation over time. Participants were recruited by purposive sampling, included 7 team leaders, 13 adopters, and 1 NGO as a wider system. Interview data were interpreted and conclusion were drawn according to the study framework. The second phase was to analyze complexity level of the spreading of harm reduction clinic identified from the first phase by applying the NASSS framework using Delphi technique with 17 experts. Data collection period were from February to September 2020. The results showed that the spreading of harm reduction service in community hospitals in Mae Hong Son manifested all complex, complicate, and simple domains. The complex domain found in this study were as follows. Firstly, opioid addiction in this area caused by various factors and treatment outcomes were varied depending on readiness of individual patients. Secondly, wider system showed difficulties in operating Needles and Syringe Program ( NSP) and Methadone Maintenance Treatment ( MMT) due to the inconsistency of the service and the context of community and other organizations outside the Ministry of Public Health. Lastly, there was an emerging situation, e.g. an implementation of unplanned teleconsulting system as an adaptation after some job rotation of operating personnel occured. Complicate domain found in this study included need of various resources and specific knowledge for running a harm reduction service, and hospital personnel were anxious of their own operating capacity. Moreover, the community hospitals needed to adapt their work process and resource management in readiness for operating the harm reduction service. Simple domain was found as the value of demand and supply that led to patients' satisfaction with the service. In conclusion, by consideration of the following details, possibility of success and sustainability of the spreading of harm reduction service in the areas other than Thanyarak Hospitals could be enhanced. Such the consideration can be an establishment of work plan for the complicate domain, as well as preparation for an emerging situation in the complex domain. These could be done by the Thanyarak Hospitals make a contribution to the community hospitals before starting any project regarding drug addiction.